I'm 34 M living in Ontario Canada. Over the last 4/5 years I've had some hemorrhoid flare-ups, nothing overly painful moreso annoying. In about January, I thought I had a thrombosed hemorrhoid, went to the clinic, they said "yes it's a hemorrhoid" and have me some prescribed ointment and sitz bath. At that point my pain was at about 5/6 out of 10. It only got worse, I'd say the pain level got up to a 9, maybe even worse. No sleeping, constant throbbing. The area around my butt cheeks were super tense and swollen. About the 4th day in it burst. The colour was a very dark purple/red colour. Immediate relief. Not to be gross, but the smell was very bad. So I decided to go again to the clinic to see if it was an infection of sorts. They said it was fine it must've been a cyst.
Fast forward to last week. I had a bowel movement before work and immediately knew it was coming back. So right away I started on sitz baths, and the prescribed ointment. I figured I could stop it before it got as bad as last time. I was wrong. I ended up doing a road trip about 8 hours there and 8 hours back. Plus 6 hours sitting for an event. Excruciating pain. Once I came back I figured I'm going to the doctor to get this thing removed for good. Once I got there they said, that's definitely not a hemorrhoid, without even looking at it. I guess because the pain and area effected was the exact same place as my first go with it. After a long wait a doctor looks at it and says, "it's a perineal abscess, you need immediate surgery". I was excited to get relief. The doctor gave a needle for localized anaesthesia (super painful), and he said he'd be back in 15 to operate. When he came back I was still in pain, I told him, and he said "that's normal, there's alot of pressure there", and began the procedure. I felt the entire operation, I was basically grunting and yelling the whole time. Not sure if that's normal or not, I figure the anesthetic didn't work.
I can say I have a very high pain tolerance. But that surgery was 10/10 worst pain ever. It was worth it for not having the constant throbbing of the abscess all day.
Now I'm waiting to see if I need a second surgery if a fistula surgery.
As a Canadian our system may be free, but I can say that you need to se multiple doctors for any issue to really find out what the problem is. Over the course of both abscess events I saw 5 doctors, the 5th one actually took care of it and gave me the proper diagnosis. I had surgery 2 days ago and feel great. Getting daily bandage changes from the nurse, bowel movements aren't great just because of the bandages being in the way.